Cosine transform based preconditioners for total variation deblurring

In PDE image restoration problems, one has to invert operators which is a sum of a blurring operator and an elliptic operator with highly varying coefficient. We present a preconditioner for such operators, which can be used with the conjugate gradient (CG) method, and compare it with Vogel and Oman's product preconditioner.

Comparative analysis of mammalian stanniocalcin genes

The recent discovery of mammalian stanniocalcin (STC) prompted an investigation of its gene structure and expression pattern to study its function and regulation. We show that both the human and mouse genes are composed of four exons spanning about 13 kb, with 85% nucleotide sequence identity in coding regions. Remarkably high sequence conservation between species also exists in the approximately 3-kb 3'-untranslated region. Comparative analysis of the 5'-untranslated region and flanking DNA from the rat and human STC genes showed long stretches of CAG trinucleotide repeats and an additional (CA)25 dinucleotide repeat unique to the rat promoter. An analysis of STC expression in the mouse showed that ovary contained the highest level of messenger RNA, with lower, but detectable, levels in most tissues. In situ hybridization revealed strong, specific hybridization over the thecal-interstitial cells of the ovarian stroma, whereas immunohistochemical analysis indicated that STC was present not only in the stroma, but also in the corpora lutea and oocyte of the developing follicle. Consequently, STC may act as a signaling molecule between the thecal-interstitial cell compartment and the corpus luteum and oocyte, thereby regulating the activity of these structures in some way. These findings suggest that in addition to its role in mineral metabolism, STC has acquired an important function in reproduction during its evolution to mammals.

Triggers of daily life ischaemia

OBJECTIVE

To determine the usual triggers of silent and symptomatic ischaemia.

DESIGN

Patients wore an ambulatory recorder for 48 hours. The device emitted a tone on detection of ischaemia and patients noted activities, feelings, and symptoms so that ischaemia could be attributed to one of four triggers: physical stress, mental stress, combined physical/mental stress, or no stressor.

SETTING

Home environment.

PATIENTS

Patients (n = 38) with stable coronary disease, positive exercise electrocardiography, and ischaemic episodes on ambulatory electrocardiography.

MAIN OUTCOME MEASURE

Matching ischaemic episodes with perceived triggers.

RESULTS

Altogether 257 ischaemic episodes (53% silent) were documented. Triggers were: physical stress, 56%; mental stress, 5%; combined physical/mental stress, 8%; no identifiable trigger, 31%. Episodes associated with mental or no stress were more often silent (69% and 75%, respectively) than those associated with physical stress (45%, p < 0.01), while combined physical/mental stress episodes were usually symptomatic (10% silent, p < 0.01 v other stressors). Although physical stress was less commonly a trigger of silent ischaemia than angina (47% v 65%, p < 0.01), it was still the predominant trigger of silent ischaemia. There was no identifiable trigger in 45% of silent and only 17% of anginal episodes (p < 0.01). Only nine silent episodes involved mental stress alone as a trigger.

CONCLUSIONS

Daily life ischaemia is usually triggered by physical activity. Mental stress alone is an uncommon trigger of either silent or symptomatic ischaemia, while combined physical/mental stress is a significant but minor trigger of angina. Patients can identify a trigger in 83% of anginal episodes, compared with only half of silent ischaemic episodes.

Dermatopathologic findings in 20 cases of systemic amyloidosis

The clinical findings of systemic amyloidosis are often variable and nonspecific. The early recognition of this disorder relies upon clinical suspicion, and definite diagnosis requires the confirmation of amyloid deposits in tissue. We reviewed 31 skin biopsy specimens from 20 patients, including 17 with amyloid light chain (AL) protein amyloidosis and 3 with serum amyloid A (AA) protein amyloidosis. Histologically, amyloid can be present in the papillary dermis, reticular dermis, subcutis, around the appendages, and in or around blood vessels. In our series, all 20 patients had at least one positive skin biopsy. Amyloid was found in 30 of 31 specimens (97%), a higher rate than in most series. Skin biopsy is a simple, safe procedure with high yield and may be used to obtain a firm diagnosis of systemic amyloidosis.

The co-localization of stanniocalcin protein, mRNA and kidney cell markers in the rat kidney

Stanniocalcin (STC) is a glycoprotein hormone that was first discovered in fish and recently identified in mammals. STC immunoreactive (STCir) cells have been identified in rat kidney and there is also evidence that the hormone functions as a regulator of renal phosphate homeostasis. In the present study we have identified STCir cells and tubules in the rat kidney by correlative immunocytochemistry using antibodies to STC and specific antigenic markers (Tamm-Horsfall protein and anion exchanger-1). The cellular sites of STC gene expression were also identified by in situ hybridization. Correlative immunocytochemistry revealed that STCir was present in all proximal straight tubule cells, all cortical thick ascending limb cells, all distal convoluted tubule cells, and both principal and alpha-intercalated cells of the collecting duct system. On the other hand, in situ hybridization revealed that the STC gene was expressed only in cortical and medullary collecting duct cells. This suggests either that STC is being sequestered by segments that do not express the gene (making them putative targets of the hormone), or that STC mRNA levels were simply too low in these other segments to be detected by in situ hybridization.

CGG repeat interruptions in the FMR1 gene in patients with infantile autism

We determined the CGG repeat length and AGG interruptions in the FMR1 gene in normal Chinese subjects and patients with infantile autism and mild mental retardation. Genomic DNA was investigated by PCR and Southern hybridisation for CGG repeat number and PCR with Mnl I restriction analysis for AGG interruption. Both the normal subjects and the patients with autism have 53 CGG repeats in FMR1, and the majority have two interspersed AGG. Our normal Chinese subjects have a similar number of interspersed AGG as other populations. When compared with the normal subjects, the autism patients have less AGG interruptions and a different pattern of AGG distribution. There was a significant difference in the CGG configurations between normal subjects and patients with autism. The latter had less interspersed AGG, as in fragile X patients, but they did not have fragile X. A study on mentally retarded patients with no infantile autism should also be carried out to ascertain whether mental retardation alone may have contributed to such AGG pattern.

Characteristics of dropouts from a child psychiatry clinic in Hong Kong

There is, to date, no study on the pattern of dropping out from child and adolescent psychiatry clinics in a non-western setting. This study aims to investigate this phenomenon in Hong Kong. The database and medical charts of 235 new cases were reviewed 1 year after the initial assessments. The clinical, demographic and family data of the dropout and non-dropout groups were compared. An overall dropout rate of 27.2% was found. Boys and children with attention deficit hyperkinetic disorder and infantile autism were less likely to drop out. No interaction with gender was found. Compared with western literature, there are some important differences in the factors associated with dropping out of treatment. Our study highlights the importance of socio-cultural influences on the characteristics of clinic drop-outs.

Total variation blind deconvolution

In this paper, we present a blind deconvolution algorithm based on the total variational (TV) minimization method proposed. The motivation for regularizing with the TV norm is that it is extremely effective for recovering edges of images as well as some blurring functions, e.g., motion blur and out-of-focus blur. An alternating minimization (AM)implicit iterative scheme is devised to recover the image and simultaneously identify the point spread function (psf). Numerical results indicate that the iterative scheme is quite robust, converges very fast (especially for discontinuous blur), and both the image and the psf can be recovered under the presence of high noise level. Finally, we remark that psf's without sharp edges, e.g., Gaussian blur, can also be identified through the TV approach.

Liposarcoma: a review of current diagnosis and management

Liposarcoma is an uncommon sarcoma. Its presentation can be deceptive, varying from innocuous to frank malignancy. Liposarcoma behaves differently from other sarcomas. This article highlights the key prognostic factors of liposarcoma, based on current literature, and suggests a plan of management.

Creutzfeldt-Jakob disease in Hong Kong

Two elderly patients presented with rapidly progressive dementia and their electroencephalograms showed periodic discharges. Creutzfeldt-Jakob disease was pathologically confirmed in one of the patients. Striking clinical features and characteristic electroencephalograms should prompt the clinical diagnosis in most patients.

Querulous behavior

A case of querulous paranoia is reported and the diagnostic, treatment and legal aspects of querulous-litigious behaviour are summarized.

Detection of Epstein-Barr virus in primary cutaneous amyloidosis

To determine the association of Epstein-Barr virus (EBV) with primary cutaneous amyloidosis (PCA), a retrospective study was conducted on skin tissue from 27 Chinese patients with lichen amyloidosus and macular amyloidosis. In situ hybridization with oligonucleotide probes was used to detect the expression of EBV-encoded RNAs (EBERs). Eleven of 27 cases (40.7%) were found to contain the EBV genome. No EBV genome was detected in the skin of the control groups, including three cases of secondary cutaneous amyloidosis, two cases of primary systemic amyloidosis, and four cases of lichen simplex chronicus. Our study showed no correlation between the presence of EBV in PCA patients and the patients' age, sex, clinical type or severity of the skin lesions. Although our results suggest that EBV may be associated with some cases of PCA, the true aetiological role of EBV in PCA remains unknown.

Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments of disability in multiple sclerosis

OBJECTIVES

To compare the judgments of clinicians on which domains of health in the short form questionnaire (SF-36) would be most important to patients with multiple sclerosis with the opinions of patients themselves; to compare assessment of physical disability in multiple sclerosis by a clinician using Kurtzke's expanded disability status scale and a non-clinically qualified assistant using the Office of Population Census and Surveys' (OPCS) disability scale with self assessment of disability and other domains of health related quality of life by patients using the SF-36 and the EuroQol questionnaire; and to compare the scores of patients for each domain of the SF-36 with control data matched for age and sex.

DESIGN

Cross sectional study.

SETTING

Clinical department of neurology, Edinburgh.

SUBJECTS

42 consecutive patients with multiple sclerosis attending a neurology outpatient clinic for review or a neurology ward for rehabilitation.

MAIN OUTCOME MEASURES

Scores on the SF-36; EuroQol; Kurtzke's expanded disability status scale; the OPCS disability scale.

RESULTS

Patients and clinicians disagreed on which domains of health status were most important (chi 2 = 21, df = 7, P = 0.003). Patients' assessment of their physical disability using the physical functioning domain of the SF-36 was highly correlated with the clinicians' assessment (r = -0.87, P < 0.001) and the non-clinical assessment (r = -0.90, P < 0.001). However, none of the measures of physical disability correlated with overall health related quality of life measured with EuroQol, Quality of life correlated with vitality, general health, and mental health in the SF-36, each of which patients rated as more important than clinicians and for each of which patients scored lower than the controls.

CONCLUSIONS

Patients with multiple sclerosis and possibly those with other chronic diseases are less concerned than their clinicians about physical disability in their illness. Clinical trials in multiple sclerosis should assess the effect of treatment on the other elements of health status that patients consider important, which are also affected by the disease process, are more closely related to overall health related quality of life, and may well be adversely affected by side effects of treatment.

Daidzein sulfoconjugates are potent inhibitors of sterol sulfatase (EC 3.1.6.2)

Recent studies have associated high dietary isoflavone intake with low incidence of breast cancer. Since estrogenic steroids are important factors in the evolution of breast cancer, and in breast tumors they are derived mainly from the sterol sulfatase pathway, we have therefore investigated effects of the isoflavone daidzein and its sulfoconjugates, daidzein-4'-O-sulfate and daidzein-7,4'-di-O-sulfate, on sterol sulfatase acitivity using dehydroepiandrosterone sulfate as substrate. While daidzein does not affect sterol sulfatase, its sulfoconjugates are potent inhibitors of this enzyme. Kinetic analyses reveal that daidzein-4'-O-sulfate and daidzein-7,4'-di-O-sulfate inhibit sterol sulfatase competitively with respect to the steroid substrate and with Ki values of 5.9 and 1 microM, respectively. Daidzein sulfo-conjugates also inhibit hydroxysteroid and phenol sulfotransferases but at much higher concentrations. These results provide a biochemical basis for the putative chemopreventive role of dietary isoflavones against breast cancer.

Acute fulminant neuropathy in a patient with Churg-Strauss syndrome

We report a patient with an acute neuropathy initially mimicking Guillain-Barré syndrome, both clinically and electrophysiologically. Persistent eosinophilia, positive antineutrophil cytoplasmic antibody and eosinophilic vasculitis in sural nerve biopsy later confirmed Churg-Strauss syndrome. Since vasculitic neuropathy can present in an acute and fulminant form, the role of early antibody testing and sural nerve biopsy in atypical cases of acute neuropathy is emphasized.

Assessment of sediment toxicity using different trophic organisms

The main aim of the present project is to study the feasibility of using different trophic organisms for evaluating the toxicity of dredged sediments arising in Hong Kong. A total of eight sediment samples (duplicate samples collected from four selected sites: Kowloon Bay, Tsing Yi,Chek Lap Kok, and Double Haven) of Hong Kong coastal waters were analyzed for the total concentrations of As, Cd, Cr, Cu, Hg, Ni, Pb, and Zn, total organic carbon, acid volatile sulfides, simultaneously extracted metals, redox potential, and 12 organic micropollutants. The sediment elutriates were also analysed for the various metal concentrations, as well as contents of ammonia-N, nitrate, total sulfide, sulfate, and total organic carbon. Elutriate Sediment Toxicity Tests (ESTT) were also conducted, using two microalgae (Skeletonema costatum, a diatom and Dunaliella tertiolecta, a flagellate), juvenile shrimp (Metapenaeus ensis) and juvenile fish (Trachinotus obtaus). Two commercially available tests using bacteria (Microtox Test and Toxi-Chromotest) also were employed to test both the solid phase and elutriates of the sediments. The results of Microtox test on the solid phase, and bioassay tests using diatom on the sediment elutriate, especially the former, were correlated significantly (p < 0.05) with a number of physico-chemical properties of sediments and elutriates. It is recommended that a combination of a liquid-phase bioassay using diatom and a solid-phase bioassay using Microtox test should be used for screening a large number of sediment samples. However, the presence of ammonia in the sediments containing a high content of organic matter seemed to interfere the detection of contamination impacts.

Psychiatric morbidity following miscarriage: a prevalence study of Chinese women in Hong Kong

OBJECTIVE

Previous studies reported that 48-51% of women in Western countries developed depressive disorder following a miscarriage. There is, however, little data among non-Western populations. The aim of this study was to measure the prevalence of psychiatric morbidity following miscarriage among Chinese women in Hong Kong.

METHODS

Subjects were interviewed immediately after a miscarriage to collect medical, psychiatric, and sociodemographic data. Six weeks following the miscarriage, 150 subjects were assessed with the Structured Clinical Interview for DSM-III-R (SCID) to establish psychiatric diagnoses.

RESULTS

18 subjects (12%) met the DSM-III-R criteria for major depression and 2 subjects (1.3%) were diagnosed anxiety disorder NOS six weeks after the miscarriage.

CONCLUSIONS

Chinese women in Hong Kong have a lower rate of psychiatric morbidity after a miscarriage.

Screening psychiatric morbidity after miscarriage: application of the 30-item General Health Questionnaire and the Edinburgh Postnatal Depression Scale

OBJECTIVE

Psychiatric morbidity affects 48% to 51% of women who have miscarried. This study evaluated the utility of two sample and brief self-report questionnaires in screening psychiatric morbidity after miscarriage.

METHOD

One hundred fifty-six subjects completed the 30-item General Health Questionnaire (GHQ), the Edinburgh Postnatal Depression Scale (EPDS), and the Beck Depression Inventory (BDI) 6 weeks after miscarriage. Then there was a blind assessment using the Structured Clinical Interview for DSM-III-R (SCID) to establish psychiatric diagnosis. The criterion validity of GHQ and EPDS were tested against this yardstick diagnosis and the concurrent validity against the BDI scores. The internal consistency of the scales was measured by Cronbach's alpha-coefficient.

RESULTS

Both GHQ and EPDS had good sensitivity and specificity in screening for psychiatric morbidity after miscarriage. The concurrent validity and the internal consistency of both scales were satisfactory. The EPDS could only identify those subjects with major depression. The GHQ was longer to perform, but was able to detect both anxiety and depressive disorders. Furthermore, the GHQ had better psychometric properties when compared with the EPDS.

CONCLUSIONS

These scales will be particularly useful for nonpsychiatric medical personnel. We recommend routine application of the GHQ 6 to 8 weeks after miscarriage to identify women who may require psychiatric management.

Effects of the insect growth regulator (S)-methoprene on survival and reproduction of the freshwater cladoceran Moina macrocopa

This study examines the acute and chronic effects of the insecticide (S)-methoprene on the survival and reproduction of the freshwater cladoceran Moina macrocopa. In laboratory toxicity tests, the 24- and 48-h LC50 values for (S)-methoprene were 0.51 and 0.34 mg litre(-1), respectively. Survival, longevity and fecundity were reduced at 0.05 mg litre(-1) and higher concentrations. At 0.005 and 0.01 mg litre(-1), longevity and fecundity increased slightly as compared to control animals. If environmental concentrations of methoprene do not exceed 0.05 mg litre(-1), as is generally the case, application of this insecticide is unlikely to induce detrimental effects on natural cladoceran populations. The stimulatory effect of very low levels of methoprene on reproductive performance is consistent with the hypothesis of a regulatory role of juvenile hormone-like compounds in crustacean reproduction.

Dropping out from child psychiatric treatment: reasons and outcome

This study explores the reasons underlying dropping out from a child psychiatric clinic in Hong Kong, and the outcome of these children. A reluctance to accept psychiatric help, or the possibility of being labelled as psychiatrically ill, and differences between the families and doctors in their perception of the presenting problems are common reasons given for dropping out. A substantial number of children who dropped out continued to have some degree of psychiatric morbidity two years later. These results highlight the need to increase the community's awareness of the nature of child psychiatry, and for doctors to be sensitive to the families' perception of the presenting problems so as to minimise the likelihood of dropping out.

In vitro immunosuppressive effects of methotrexate and azathioprine on Langerhans cells

The long-term use of immunosuppressive agents may cause profound suppression of the cutaneous immune function. Because epidermal Langerhans cells (LC) play an important role in the cutaneous immune system, they could be the target of immunosuppressants. Since little information is available about the direct immunosuppressive effects of methotrexate (MTX) and azathioprine (AZA) on LC, we studied the viability and immunostimulatory effects of purified LC after pulsation with MTX or AZA at various concentrations. Both MTX and AZA started to suppress the mixed LC-T lymphocyte reaction (MLCLR) significantly at a concentration of 1 microgram/ml. However, the suppressive effect of MTX was not dose-dependent; no further suppression was seen up to a concentration of 1 mg/ml. MTX showed no inhibitory effect on the viability of LC even at concentrations as high as 1 mg/ml. In contrast, the suppressive effect of AZA on the MLCLR was dose-dependent and AZA at a concentration of 500 micrograms/ml or higher markedly decreased the viability of LC. Our study confirmed the immunosuppressive effect of MTX and AZA on epidermal LC. In comparison to MTX, AZA at pharmacological levels showed stronger inhibitory effects on alloantigen-presenting capacity of human epidermal LC and was more cytotoxic to LC. In the therapeutic range, however, MTX and AZA probably have no direct effect on epidermal LC. Our study supports the notion that long-term immunosuppressants deplete cutaneous LC by bone marrow suppression.

Inter-rater reliability of ICD-10 in Chinese patients

In an attempt to assess the universal applicability of the International Classification of Disease (ICD-10), two psychiatrists from different socio-cultural backgrounds and training independently performed a chart review of 238 Chinese patients. Inter-rater reliability figures were comparable to those found in the WHO-coordinated ICD-10 field trials. The results suggest that ICD-10 has good ‘universality’ in routine clinical practice.

Attempted suicide by Chinese elderly in Hong Kong

There is little information on attempted suicide in the elderly, especially among Chinese populations. Fifty-five elderly with suicidal attempts seen in a psychiatric unit in Hong Kong over a 2 1/2 year period were studied. The risk of suicidal attempt remained high after age 75 and only declined after 85. In contrast to western societies, self-injury was more common than self-poisoning. About half of the patients suffered from a mood disorder but very few had dementia. At follow-up 1 1/2-4 years after the suicidal attempt, the rate of repetition was 3.6% and the rate of completed suicide was 5.5%.